If the wound contains necrotic tissue, debridement (surgical, mechanical, or enzymatic) is usually recommended. Exceptions exist depending on wound etiology, the amount of necrotic tissue, wound characteristics, patient status, goals of therapy, and other considerations.
Bacterial control is essential for healing to progress. The extent of infection needs to be rapidly determined. Diagnosis depends on clinical signs of infection, plus culture results to identify bacteria and fungi. Treatment requires topical and/or systemic antimicrobial therapy.
Once the wound is irrigated, cleansed and debrided, wound dressings provide a protective barrier and are critical for filling dead spaces, for delivering antimicrobials, and for maintaining a moist environment.
Therapeutic and adjunctive therapies, such as negative pressure wound therapy, promote healing by creating the appropriate conditions for cell activation and progression through the phases of healing.